Pyelonephritis in urological practice occurs in more than half of patients who turned to a specialist with kidney problems. The inflammatory process most often develops due to the penetration of an infectious agent with blood, lymph, or from the lower organs of the urinary system. Treatment of obstructive pyelonephritis is a long and complex process.
Types of disease
There is no single universally accepted classification of pyelonephritis in medicine. In clinical practice, it is customary to separate pyelonephritis by the nature of the course:
- acute and chronic;
- obstructive and non-obstructive;
- primary and secondary.
Pyelonephritis, arising from the already existing urological pathology, is considered to be obstructive. The treatment of this form of the disease is especially difficult, since it should not only prevent the development of inflammation in the renal pelvis, but also in the ureter and bladder. Uronephrology also classifies pyelonephritis in children, pregnant women, the elderly (senile pyelonephritis), pathology that develops in diabetes mellitus, etc. Depending on the course of the disease and the individual characteristics of each patient, the therapy will be different.
Forms of Obstructive Pyelonephritis
Uronephrology distinguishes two forms of the course of the disease:
- acute, which is characterized by a sharp increase in temperature to 39-40 degrees, fever, loss of consciousness, the presence of blood and sediment (epithelium) in the urine, pain in the lower back and a sharp burning sensation when urinating;
- chronic, which is characterized by low-grade fever (37-37.5 degrees), weakness, asthenia, low blood pressure, aching lower back pain and burning sensation when urinating.
Acute obstructive pyelonephritis requires immediate hospitalization of the patient. In the absence of timely medical intervention, a fatal outcome is possible.
Symptomatology
Symptoms of chronic obstructive pyelonephritis:
- chronic fatigue;
- the development of vegetative dystonia;
- hypotension;
- dizziness, headaches;
- loss of strength even after minor physical effort;
- constant low-grade fever;
- burning sensation during urination;
- cystitis;
- small portions of urine with frequent urination.
The chronic form of the disease can haunt the patient for months before he decides to undergo a full examination. The longer the sick person is pulled with the diagnosis, the greater the damage to the tissues of the urinary system.
The acute form of the disease does not go unnoticed: high fever, fever and chills make the patient inoperative. A critical condition should cause an emergency call and hospitalization in the nephrological or urological department.
Reasons for the development of the disease
The reasons why obstructive pyelonephritis develops in children and adults:
- congenital or acquired pathologies of the urinary system;
- once experienced chronic pyelonephritis of the usual course;
- frequent inflammatory diseases of the bladder;
- pregnancy can be a catalyst for the development of obstructive pyelonephritis;
- adenoma in men;
- hypothermia of the lower back or the whole body;
- diabetes often provokes the development of inflammatory diseases of the kidneys and bladder;
- gout;
- prolonged and uncontrolled use of antibiotics;
- surgical interventions;
- psycho-emotional stress and chronic stress;
- infectious diseases of other organs.
The consequences and complications of the disease
Why should you never let it go and leave the symptoms of obstructive pyelonephritis untreated? The fact is that this disease often causes complete renal dysfunction, bacteriotoxic shock, necrotic papillitis, arterial hypertension.
- Chronic renal failure (CRF) is a condition that develops under the influence of pathogenic compounds, in which there is a malfunction and death of organ tissues. The complete loss by the kidneys of their functions is characteristic. Without a blood transfusion, a person dies within five to seven days. Therefore, in the diagnosis of chronic renal failure, the patient is forced to attend hemodialysis procedures for the rest of his life and stand in line for a donor kidney transplant (in some cases, two are required at once). In our country, waiting for an organ transplant is not always possible, therefore, in some cases, people die without waiting for surgery.
- Bacteriotoxic shock develops if obstructive pyelonephritis is accompanied by the release of pus. This complication of pyelonephritis with bilateral kidney damage is extremely dangerous. In about half the cases, it is fatal. With unilateral obstructive pyelonephritis, the probability of death with the development of bacteriotoxic shock is 35%. During pregnancy, bacteriotoxic shock leads to fetal death in almost all cases.
- Necrotic papillitis is the most rare complication of obstructive pyelonephritis. It develops most often as a result of a violation of the process of production and discharge of urine from the bladder. An increase in intrarenal pressure occurs. This leads to impaired blood flow to the organ. There is damage to the papillae of the kidneys and their further oxygen starvation. Then, necrosis of the tissues of the bladder and kidneys develops.
Diagnostic Methods
Diagnosed with obstructive pyelonephritis (ICD 10 code - N11.1) after the following studies:
- urine culture (allows you to determine the type of pathogenic bacterium that caused the development of inflammation - most often it is Escherichia coli, staphylococcus, enterococcus);
- ultrasound diagnostics (ultrasound) allows you to examine kidney tissue and determine the presence of pus, stones, sand;
- computed tomography (CT) scan does not have significant advantages over ultrasound. It is mainly useful for differentiating pyelonephritis with tumor processes.
Antibiotic therapy
Treatment of any inflammatory process is not complete without taking antibiotics. Only these drugs can suppress the activity of pathogenic microorganisms and destroy their spores. If pyelonephritis of any form is not treated with antibiotic drugs, it will go into the chronic stage and provoke necrosis of the tissues of the urinary system.
In addition, in the absence of adequate antibiotic therapy, secondary obstructive pyelonephritis often develops. In children, this process can provoke the formation and discharge of pus, which ultimately leads to bacteriotoxic shock and, in some cases, death.
The duration of treatment and the type of antibiotic are prescribed by the neurophrologist after studying the test results. Most often, the following drugs are effective:
- "Cefixime" - can be used both in the form of liquid for injection and in the form of tablets;
- Ceftibutene in the form of capsules or tablets;
- "Cefuroxime" both in the form of a liquid for injection and in the form of tablets.
Surgical intervention
Surgical treatment is indicated if standard antibiotic therapy methods fail.
Mostly purulent forms of obstructive pyelonephritis are operated on. With its classical course, there is most often no need for intervention. the operation is usually quick and without complications. The main goal of surgery for obstructive pyelonephritis is to stop the purulent-inflammatory process in the kidney or bladder. It is also important to restore the outflow of urine along the upper urinary tract.
Homeopathic treatment
The modern pharmacological market offers many drugs for the treatment of inflammatory diseases of the kidneys. There are a lot of homeopathic medicines among them, the action of which is based on herbs:
- "Kanefron";
- "Fitolizin";
- "Renel";
- Monural.
Uronephrologists emphasize that these drugs can be used to treat obstructive pyelonephritis (popo M 10 code - N11.1) only as part of complex therapy. Only antibiotic drugs can kill pathogenic microflora. Yes, in some cases they are toxic and lead to complications of diseases of the gastrointestinal tract. But without their use, pyelonephritis cannot be cured.
After repeated tests confirm the complete destruction of the pathogen of inflammation, you can restore urination using "Kanefron" or "Monural". And as an independent means of therapy, these drugs are useless.
Prevention of exacerbation of pyelonephritis
If in the patientβs history there was at least one case of diagnosis of obstructive pyelonephritis, then it is likely that from time to time it will resume in a chronic form. Therefore, it is very important to observe the following preventive rules to maintain kidney health:
- avoid overcooling of both the whole body and its individual sections (especially the legs and lower back);
- monitor nutrition: from time to time arrange fasting days without salt and on some carbohydrates (apples, rice, buckwheat porridge);
- Do not abuse alcohol or smoke (nicotine and tar have a destructive effect on kidney tissue);
- follow the water regime: for the condition of the kidneys, not only the lack of clean drinking water, but also its excess is fatal;
- healthy sleep and rest are necessary: ββevery night you need to sleep at least eight hours, if necessary, try to sleep for an hour or two.
You should avoid stress and prevent the development of chronic fatigue: a psycho-emotional state is important for the organs of the urinary system. Many kidney diseases are psychosomatic in nature. As a result of nervous breakdowns, not only neurons, but the whole body suffer.